Beginning Saturday, Iowa’s new Medicaid insurer Molina Healthcare will administer benefits to 205,181 Iowans under Medicaid and Hawki as the insurer officially joins the state program.
July 1 marks the start date for two managed care agreements with Iowa Medicaid, a joint state and federal program that funds approximately $7 billion annually in health care for more than 750,000 Iowa citizens who are poor or disabled.
The state also awarded another four-year contract to Medicaid insurer Amerigroup Iowa, which will oversee benefits for 277,161 Iowans starting later this week, according to data provided by the state Wednesday.
Iowa Total Care has a managed care agreement with Iowa that runs through 2025. The insurer will administer benefits to 269,692 members.
The majority of the vulnerable population under Medicaid, the more than 106,000 disabled and others in need of long-term support and services, will return to Amerigroup and Iowa Total Care effective July 1.
Amerigroup will administer benefits to approximately 44,000, while Iowa Total Care will oversee nearly 39,000. The remaining nearly 24,000 will fall under Molina.
With Molina’s contract in effect, the state program will have three private insurance companies administering benefits to Iowans for the first time since 2017.
State officials said adding another insurance company to the program should increase choices for beneficiaries and help the state improve health outcomes by increasing access to community-based services and mental health care, among other services.
The addition of a third insurer comes as the state is pursuing a greater effort to reduce administrative burdens, align policies and procedures among managed care organizations, and improve member and provider satisfaction, said the Iowa director Medicaid Liz Matney.
The goal is to simplify, centralize, standardize as much as possible,” Matney told the Des Moines Register. make things easier for our suppliers.
Medicaid director says Iowa has been diligent in the onboarding process
This week’s shift marks the latest transition in the sometimes tumultuous history of Iowa’s Medicaid program since 2016, when the state mandated for-profit insurance companies to administer member benefits.
The privatized system saw the abrupt exit of two insurance companies AmeriHealth Caritas and UnitedHealthcare in 2017 and 2019 respectively due to heavy financial losses, causing disruption to patients’ healthcare.
The system has also been plagued by complaints from critics who say members have been harmed by cuts to their services and payments to providers for care that have been delayed or denied altogether.
Since taking the helm as director of Iowa Medicaid, Matney said the state has moved on from the turmoil of the program’s early days and has taken steps to create long-term stability within the program.
“A lot of what we do is based on lessons learned,” Matney said. “We have a team of people here who were really invigorated towards continuous quality improvement not only in the health care they were providing, but also in how efficiently they were running the program.
In the months leading up to the contract start dates, Matney said the state was being diligent in its onboarding process with the new insurer and contracted with the Arizona-based Health Services Advisory Group (HSAG) to conduct an external quality review of the organization’s managed care availability.
The review, which was released earlier this month, found that Molina “met all operating standards assessed in the readiness review and demonstrated sufficient operations” to administer benefits to Iowa Medicaid members.
Iowa Medicaid officials will be incorporated into Molina’s operations onsite during the first 30 days of operations. Matney said the first month is when officials can identify any systemic issues, such as problems with pre-authorization for services or denial rates.
The state has also engaged with health care providers to conduct grievance testing with Molina’s system to ensure providers are paid on time. Matney said the insurer will also plan to manually review every single provider claim in the first 30 days of implementation to ensure the system is working as intended and to catch any problems early.
When we implemented managed support in 2016, it didn’t happen and we had been looking for a solution for a while,” Matney said. .
What are critics saying about Iowa’s Medicaid system?
Despite the state’s reassurances, some elected officials are still concerned about the impending transition, especially given that problems within the Medicaid system have led to disruptions in patient care.
Since handing over the reins to private insurance companies, Iowa’s Medicaid program “has been a disaster and a failure in every way,” Senate Democratic leader Pam Jochum, a longtime critic, said in a statement. the privatization of Medicaid.
Huge multistate insurance companies have profited from state funds, while low-income families and the most vulnerable Iowas have struggled to access critical care,” Jochum said. The state’s new MCO contract with Molina reminds us we must remain vigilant to account of Iowans who depend on Medicaid and hold providers accountable for the services they are obligated to provide.
“This issue is deeply personal to me and I will be following the implementation of Molina’s contract closely.”
Some advocates are also concerned about the timing of the new insurer’s onboarding, as it’s happening at the same time the state is ending its continued coverage requirement for Medicaid.
Over the next year, more than 100,000 Iowans are expected to be delisted from the state’s program after the federal public health emergency ends in May. As part of the COVID-19 response, federal officials have allowed for increased eligibility of safety net health insurance.
Moreover:More than 100,000 Iowans will soon lose Expanded Medicaid. What you need to know:
Requiring members to fill out redetermination paperwork at the same time they’re selecting a new insurer could lead to confusion among Medicaid members, making qualified individuals more likely to miss key deadlines and lose their benefits, said Anne Discher, executive director of Common Good Iowa.
The more moving parts you put into any kind of system, the more confusing it is for people and the more places there are where things can go wrong,” Discher said. “In a way, it’s awkward timing.
Matney agreed that the timing of Iowa’s Medicaid “rolling out” period is less than ideal.
However, he said state and managed care organizations have been working to distinguish the two processes as much as possible and have engaged with members to ensure people don’t lose their coverage. This includes face-to-face contact to ensure members fill out the proper paperwork, Matney said.
How was Molina selected to participate in Iowa’s Medicaid program?
Molina and Amerigroup were chosen a year ago from a pool of five potential bidders vying to join the program following Iowa’s call for proposals in February. The three losing companies were Aetna Health of Iowa, CareSource Iowa and UCare Iowa.
A cursory review of the proposals provided by the Iowa Department of Health and Human Services showed that Molina received the highest score among an evaluation of all five bidders, followed by Amerigroup.
Strengths listed by the “HHS Agency Multidisciplinary Team” that evaluated Molina included past experience and successes with similar services, experience with long-term support and services population in other states, and leadership hires with extensive experience in Iowa.
The state also said the new insurer had a “well-documented early engagement with vendors and stakeholders” that demonstrated advanced preparedness. In its bid response, Molina officials said it had met with providers, patients and their families, advocates and other interested parties for three years before bidding on the managed care contract.
“By speaking with representatives from every AI Health Link population group, we gained a deep understanding of the current needs, opportunities, and successes of the IA Health Link program, which informed every strategy and approach we used to design our AI Health Program Health Link plan,” Molina officials wrote.
Molina has been the subject of disciplinary action by federal and state regulators.
In June of last year, the company and its subsidiary Pathways of Massachusetts paid $4.5 million for alleged False Claims Act violations. Federal officials said Molina owned and operated mental health centers that improperly filed claims refund without properly authorizing and supervising its personnel.
A few days earlier, also in June 2022, the state of California fined Molina $1 million over the company’s failure to resolve more than 29,000 supplier disputes in 2017 and 2018.
It also paid Texas regulators $500,000 in 2019 after allegedly failing to pay beneficiaries’ claims on time.
Losing Medicaid bidder claims conflict of interest in new lawsuit
CareSource Iowa, the Ohio-based non-profit managed care company that failed to win a contract in Iowa, filed a civil petition in Polk County District Court earlier this month accusing officials state that it chose Molina to join the program despite a conflict of interest.
Moreover:Alleged Conflicts of Interest in Selecting Iowa Medicaid Managed Care Providers
Matney declined to comment on the lawsuit.
In its lawsuit, CareSource noted that Molina’s chief executive officer is Jennifer Vermeer, who served as director of Iowa Medicaid from 2008 to 2014.
Company officials say the competitive bidding process used by the state agency for health and human services resulted in the hiring of the “only bidder to hire a longtime colleague/supervisor of government workers as CEO who evaluated potential managed care organizations, creating an “unfair and biased outcome” to the process.
The company is seeking a judicial review of the state’s selection.
Michaela Ramm covers health care for the Des Moines Register. You can be reached at mramm@registermedia.com, (319) 339-7354, or on Twitter at@Michaela_Ramm
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